Impacts of the Affordable Care Act on Workers Compensation

Overview

The Patient Protection and Affordable Care Act (ACA) has dramatically changed the healthcare landscape in the United States. The ACA’s individual health insurance mandate, together with the state option for Medicaid expansion, have increased the number of medically insured in America by roughly 20 million people as of early 2016, with the greatest impact occurring at the time both provisions first went into effect in 2014. Another objective of the ACA is to promote population wellness, for which one point of focus is obesity reduction.

Our research addresses two questions concerning the ACA’s impacts on workers compensation:

Access to Primary Care—Has the increase in demand for primary care services by newly insured people under the ACA crowded out access to the same services by workers compensation claimants?

Obesity Reduction—If the ACA is successful in reducing population obesity in the United States, what are the potential medical cost savings to workers compensation?

Key Findings

The ACA has had no discernible impact on crowding out workers compensation claimants from access to primary care services through 2014, the first full year of expanded medical insurance coverage under the ACA

68% of primary care services provided during the first 90 days of a workers compensation claim occur during the claim’s first 10 days

A reduction in the US obesity rate from 35% to 25%, in accordance with the goals of the ACA’s wellness initiative, might reduce workers compensation medical costs by 3% to 4%